Orthopedic Coding Alert

Pay particular attention to your sixth, seventh characters.

If you look at the raw data of ICD-10 code revisions, you’ll see hundreds of Salter-Harris fracture diagnosis codes listed. We’ve broken down this data into easy-to-understand groupings so that you’ll be ready for October 1, 2016.

First, Define Physeal Fractures

Children’s fractures can be more difficult to describe accurately because of the presence of the physis, or growth plate, says Bill Mallon, MD, former medical director of Triangle Orthopedic Associates in Durham, N.C. You’ll find several classification systems for fractures involving the physis. According to Mallon, by far the most widely used is the Salter-Harris system, which is as follows:

Salter-Harris Type I: In this injury, the fracture line goes directly through the physis. This would usually be an extra-articular fracture. You cannot always clearly see this fracture on radiographs, and sometimes provider must make the diagnosis on clinical suspicion.

Salter-Harris Type II: In this injury, the fracture line is mostly through the physis, but it exits one cortex such that a small fragment of metaphysis is included with the fracture fragment containing the physis and epiphysis. This would usually be an extra-articular fracture.

Salter-Harris Type III: In this injury, the fracture line is mostly through the physis, but it exits one cortex such that a small fragment of epiphysis is included with the fracture fragment containing the metaphysis and diaphysis. This fracture is always intra-articular.

Salter-Harris Type IV: In this injury, a fracture line crosses the physis such that both fracture fragments contain portions of the metaphysis, physis and epiphysis. This fracture is always intra-articular.

Salter-Harris Type V: With this injury, there is no definite fracture line, and like the Salter-Harris Type I, this injury cannot be easily diagnosed radiographically. This involves a crush injury to the physis in which the metaphysis and epiphysis are acutely impacted upon one another. This would be an extra-articular fracture.

Second, Rejoice for Easy Revisions

You’ve got some Salter-Harris revisions to learn. However, before you push up your sleeves to dig into what’s different, you can rejoice. The only thing that’s changing is the term “Salter Harris” to “Salter-Harris.” You will add the hyphen. That’s it. You’ll still report these diagnoses the same way. They are:

• S49.01-- (Salter-Harris Type I physeal fracture of upper end of humerus)
• S49.02-- (Salter-Harris Type II physeal fracture of upper end of humerus)
• S49.03-- (Salter-Harris Type III physeal fracture of upper end of humerus)
• S49.04-- (Salter-Harris Type I physeal fracture of upper end of humerus)
• S49.05-- (Salter-Harris Type IV physeal fracture of upper end of humerus).

The sixth character (1, 2, 0) will specify the right, left, or unspecified arm.

The seventh character will specify the encounter, as follows:

• A = initial encounter for closed fracture
• D = subsequent encounter for fracture with routine healing
• G = subsequent encounter for fracture with delayed healing
• K = subsequent encounter for fracture with nonunion
• P = subsequent encounter for fracture with malunion
• S = sequela.

Finally, Examine What’s New for Salter-Harris Diagnoses

You’ll have some brand new Salter-Harris diagnosis codes for physeal fractures of the calcaneous, metatarsal, and phalanx of the toe.

For Salter-Harris physeal fractures of the calcaneous, you’ll have these additions:

S99.01-- (Salter-Harris Type I physeal fracture of … calcaneous … )
S99.02-- (Salter-Harris Type II physeal fracture of … calcaneous … )
S99.03-- (Salter-Harris Type III physeal fracture of … calcaneous … )
S99.04-- (Salter-Harris Type IV physeal fracture of … calcaneous … ).

Similarly, you’ll have new codes for Salter-Harris physeal fractures of the metatarsal:

S99.11-- (Salter-Harris Type I physeal fracture of … metatarsal … )
S99.12-- (Salter-Harris Type II physeal fracture of … metatarsal … 
S99.13-- (Salter-Harris Type III physeal fracture of … metatarsal … )
S99.14-- (Salter-Harris Type IV physeal fracture of … metatarsal … ).

Check out these Salter-Harris physeal fracture codes for the phalanx of the toe:

S99.21-- (Salter-Harris Type I physeal fracture of phalanx of … toe … )
S99.22-- (Salter-Harris Type II physeal fracture of phalanx of … toe … 
S99.23-- (Salter-Harris Type III physeal fracture of phalanx of … toe … )
S99.24-- (Salter-Harris Type IV physeal fracture of phalanx of … toe … )

You’ll also have some new unspecified and other physeal codes to add to your coding cache, but you should always try to code to the highest specificity. They are:

S99.00-- (Unspecified physeal fracture of … calcaneous …)
S99.09-- (Other physeal fracture of … calcaneous …)
S99.10-- (Unspecified physeal fracture of … metatarsal …)
S99.19-- (Other physeal fracture of … metatarsal …)
S99.20-- (Unspecified physeal fracture of phalanx of … toe …)
S99.29-- (Other physeal fracture of phalanx of… toe …).

Important: For all of the above codes, you’ll apply the sixth character to specify which side (1, 2, 9) and the seventh character to specify the encounter (A, D, G, K, P, S).